RESUMO
We describe a sciatic schwannoma spanning the sciatic notch in a 39-year-old woman with persistent pelvic pain after caesarean delivery. The tumour was detected by pelvic CT scan and MRI. Anterior transabdominal surgery allowed the en bloc removal of both the pelvic and the buttock component of the tumour.
Assuntos
Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Neuropatia Ciática/cirurgia , Adulto , Cesárea , Feminino , Humanos , Imageamento por Ressonância Magnética , Neurilemoma/diagnóstico , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Gravidez , Neuropatia Ciática/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: The present case is an example of hypertrophic inflammatory neuropathy (HIN). This entity is a rare tumor-like, chronic inflammatory, focal or multifocal, mainly demyelinating neuropathy of unknown origin, most frequently involving the brachial plexus. CASE DESCRIPTION: The authors describe a 67-year-old man presenting with a nodular mass in his right supraclavicular fossa. A nodular mass grossly resembling a schwannoma originating from a single nerve fascicle was surgically removed from the right C6 spinal nerve. Histologically, endoneurial edema, fibrosis, focal chronic inflammation, and extensive "onion bulb" formation were seen. Electron microscopy studies and immunohistochemistry proved that the onion bulb-forming cells were schwannian in nature and that the whorls of onion bulbs surrounded a generally demyelinated axon. Three months following surgery the patient developed acute painless paralysis of his right biceps brachii muscle that rapidly reversed; after that he remained neurologically asymptomatic. MRI revealed multiple fusiform mass lesions involving the brachial plexus bilaterally. Electrophysiologic studies demonstrated a bilateral, asymmetrical, mainly demyelinating neuropathy involving the brachial plexus; they failed to reveal any abnormality suggestive of generalized neuropathy. CONCLUSION: HIN is different from other focal tumor-like neuropathies and in particular from localized hypertrophic neuropathy (LHN).
Assuntos
Neurite do Plexo Braquial/diagnóstico , Neurite do Plexo Braquial/fisiopatologia , Idoso , Neurite do Plexo Braquial/patologia , Neurite do Plexo Braquial/cirurgia , Eletrofisiologia , Humanos , Hipertrofia , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Microscopia Eletrônica , Tomografia Computadorizada por Raios XRESUMO
The authors describe two cases of radial paralysis due to interruption in the proximal level, treated by autologous nerve grafting, following anterior transposition. At long-term follow-up, in one case after 12 years, there was good functional recovery, while in the second case there was still no recovery after 2 years. The surgical technique involving anterior transposition of the nerve is described, which in this type of lesion facilitates neurorrhaphy.
Assuntos
Fraturas do Úmero/complicações , Transferência de Nervo/métodos , Paralisia/etiologia , Doenças do Sistema Nervoso Periférico/etiologia , Nervo Radial/lesões , Adolescente , Adulto , Humanos , Masculino , Paralisia/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Nervo Radial/cirurgiaRESUMO
OBJECTIVE AND IMPORTANCE: A unique case of primary non-Hodgkin's lymphoma of the sciatic nerve followed by multiple loci in the central nervous system is described. CLINICAL PRESENTATION: The lesion occurred in a 44-year-old immunocompetent man with a palpable mass in the left popliteal fossa and a 10-month history of progressive weakness and numbness of the left foot. The tumor was a diffuse large lymphoma of B-cell origin of an intermediate grade of malignancy according to the criteria of the International Working Formulation. INTERVENTION: Because diagnosis of the malignant lymphoma was performed on frozen section, resection of the nerve trunk was avoided. The patient was treated with radiotherapy and chemotherapy. At 6 months after the discovery, biopsy, and treatment of the sciatic nerve lymphoma, other lesions demonstrating the same histological features were observed in the central nervous system. The patient died 4 years and 2 months after presentation as a result of the central nervous system lesions and without clinical evidence of systemic extraneural localization. CONCLUSION: A review of the literature indicates that primary peripheral nerve lymphomas occur in the sciatic nerve. These cases, and the case described in our study, share common clinicopathological findings that justify discussing them separately as distinct entities.
Assuntos
Neoplasias Encefálicas/cirurgia , Linfoma de Células B/cirurgia , Linfoma Difuso de Grandes Células B/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Isquiático/cirurgia , Adulto , Biomarcadores Tumorais/análise , Encéfalo/patologia , Encéfalo/cirurgia , Neoplasias Encefálicas/patologia , Terapia Combinada , Humanos , Técnicas Imunoenzimáticas , Linfoma de Células B/patologia , Linfoma Difuso de Grandes Células B/patologia , Imageamento por Ressonância Magnética , Masculino , Neoplasias Primárias Múltiplas/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Nervo Isquiático/patologia , Tomografia Computadorizada por Raios XRESUMO
We report a case of a giant intrasacral schwannoma expanding into the presacral space. 'En bloc' resection was accomplished by an anterior, transabdominal approach. The advantages of such a procedure are discussed.
Assuntos
Neoplasias do Sistema Nervoso Periférico/cirurgia , Sacro/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Raízes Nervosas Espinhais/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Neoplasias do Sistema Nervoso Periférico/patologia , Sacro/patologia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/patologia , Raízes Nervosas Espinhais/patologia , Tomografia Computadorizada por Raios XRESUMO
We report the case of a patient who sustained an isolated injury to one of the two main branches of the posterior interosseous nerve of the forearm. Repair by epineurial suture was followed by complete recovery.
Assuntos
Traumatismos do Antebraço/cirurgia , Tecido Nervoso/lesões , Tecido Nervoso/cirurgia , Adulto , Humanos , Masculino , Degeneração Neural , SuturasRESUMO
The case of a patient with a small intraneural ganglion of the deep peroneal nerve is described, including the clinical and electrophysiological characteristics and the course four years after surgery.
Assuntos
Cistos/patologia , Gânglios/patologia , Nervo Fibular/patologia , Eletromiografia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Amyloidosis is a manifestation of a group of diseases resulting from the variable infiltration of multiple organs by a fibrillar protein called amyloid. Hepatic involvement in amyloidosis is common both in the primary and in the secondary forms, whereas clinically-dominant liver amyloidosis is relatively rare. The authors describe a case of primary systemic amyloidosis with giant hepatomegaly, portal hypertension and renal insufficiency; the patient did not develop jaundice, ascites or gastrointestinal bleeding but died 6 months later, death being due to cerebral haemorrhage.
Assuntos
Amiloidose/patologia , Hepatomegalia/patologia , Hipertensão Portal/patologia , Adulto , Amiloidose/complicações , Biópsia , Mucosa Gástrica/patologia , Hepatomegalia/etiologia , Humanos , Hipertensão Portal/etiologia , Fígado/patologia , MasculinoRESUMO
A case of solitary schwannoma and one of solitary neurofibroma originating from the spinal accessory nerve in the posterior triangle of the neck are described. Location of such neoplasms in this region is exceptional. The authors emphasize the importance of accurately enucleating the mass; when it is impossible to preserve the continuity of the neural pathway, nerve repair should be considered.
Assuntos
Nervo Acessório , Neoplasias dos Nervos Cranianos , Neoplasias de Cabeça e Pescoço , Neurilemoma , Neurofibroma , Nervo Acessório/cirurgia , Adulto , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Neurilemoma/cirurgia , Neurofibroma/cirurgia , Nervo Sural/transplante , Transplante HeterotópicoRESUMO
Duodenal biopsies obtained from seven normal subjects and six ulcerous patients were cultured in vitro for 30 min at 37 degrees C under various experimental conditions. Epidermal growth factor (EGF) and somatostatin released in the culture medium were determined by radioimmunoassay. Under basal conditions, EGF and somatostatin levels were significantly higher in normal subjects (11.49 +/- 3.07 ng/mg protein and 3.06 +/- 0.8 ng/mg protein, respectively) than in ulcerous patients (6.9 +/- 1.98 ng/mg protein and 1.75 +/- 1.23 ng/mg protein, respectively). However, when antibodies to somatostatin and vasoactive intestinal polypeptide (VIP) were added together to the culture media, in ulcerous patients, EGF levels also were lower as absolute values, but were higher as a percentage of variation than controls (p less than 0.05). The fall of EGF secretion from tissue cultures of ulcerous patients could be the consequence of endocrine cellular loss or damage, rather than the cause of ulceration. Moreover, the EGF-producing cells around the lesion in ulcerous patients seems to be hyperactive, and this hyperfunction of EGF-producing cells might contribute to the in vivo repair of tissue damage.
Assuntos
Fator de Crescimento Epidérmico/fisiologia , Mucosa Intestinal/metabolismo , Úlcera Péptica/fisiopatologia , Adulto , Anticorpos/farmacologia , Biópsia , Técnicas de Cultura , Fator de Crescimento Epidérmico/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radioimunoensaio , Somatostatina/imunologia , Somatostatina/metabolismo , Peptídeo Intestinal Vasoativo/farmacologiaRESUMO
A case of ulnar neuropathy at the elbow produced by spontaneous intraneural hemorrhage in a patient with acquired immunodeficiency syndrome and thrombocytopenia is reported. Intraneural hemorrhage in patients with bleeding disorders occurs infrequently. It consists of acute intrafascicular bleeding, presumably producing very high elevations of endoneurial fluid pressure. The clinical features and treatment of this condition are considered, the pertinent literature is reviewed, and the involved pathophysiological mechanisms are discussed.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Hemorragia/complicações , Nervo Ulnar , Adulto , Edema/patologia , Estimulação Elétrica , Fibrose , Humanos , Masculino , Condução Nervosa/fisiologia , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Trombocitopenia/complicaçõesAssuntos
Fraturas do Úmero/complicações , Nervo Ulnar/lesões , Criança , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Paralisia/etiologia , Radiografia , Fatores de Tempo , Nervo Ulnar/fisiopatologia , Nervo Ulnar/cirurgia , Lesões no CotoveloRESUMO
The CT appearance of two cases of ganglionic cysts of the common peroneal nerve at the knee is reported. In both cases the ganglion appeared as a cystic unenhanced lesion of mucoid density. The radiological findings were confirmed by surgery. The differences in the appearance of intraneural and extraneural ganglia are discussed.
Assuntos
Cistos/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Nervo Fibular/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Cistos/cirurgia , Feminino , Humanos , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/cirurgiaRESUMO
Clinical features and electrophysiologic studies indicated a lesion of the ulnar nerve in the wrist of a 50-year-old man. CT of this region revealed a ganglion inside Guyon's canal. Surgical exploration disclosed a carpal ganglion compressing the ulnar nerve just proximal to its division.
Assuntos
Doenças do Sistema Nervoso Periférico/etiologia , Cisto Sinovial/complicações , Nervo Ulnar/fisiopatologia , Punho , Eletrofisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/fisiopatologia , Cisto Sinovial/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Nervo Ulnar/diagnóstico por imagemRESUMO
The authors describe an intraneural ganglion of the sural nerve at the ankle. This cause for sural neuropathy has never previously been cited. Resection of the sural nerve together with the indwelling cyst is suggested.
Assuntos
Nervos Espinhais , Nervo Sural , Cisto Sinovial/cirurgia , Adulto , Feminino , Humanos , Doenças do Sistema Nervoso Periférico/cirurgiaRESUMO
Iliacus hematoma should be suspected as the cause of femoral neuropathy in cases of minor trauma in teenagers, especially when the onset of paralysis is delayed and therefore an acute traction injury of the nerve is unlikely. In our 14-year-old female patient the condition followed minor trauma. In such cases CT scan should be performed. When this reveals a hematoma and the nerve lesion is rapidly progressing or complete, the hematoma should be promptly evacuated.
Assuntos
Nervo Femoral , Hematoma/complicações , Síndromes de Compressão Nervosa/etiologia , Adolescente , Feminino , Virilha , Ginástica/lesões , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Quadril , Humanos , Músculos/diagnóstico por imagem , Músculos/lesões , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/cirurgia , Tomografia Computadorizada por Raios XRESUMO
A bilateral posterior compartment syndrome of the thigh with a sciatic neuropathy in a patient following a craniotomy in the sitting position is described. The pathophysiology of the sciatic nerve dysfunction is discussed and the diagnostic value of computerized tomography is emphasized. Prompt decompression of the nerve is suggested.